{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T02:33:27Z","timestamp":1785465207017,"version":"3.56.0"},"reference-count":13,"publisher":"American Medical Association (AMA)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Cardiol"],"published-print":{"date-parts":[[2023,1,1]]},"abstract":"<jats:sec id=\"ab-hoi220072-4\"><jats:title>Importance<\/jats:title><jats:p>The expansion of sodium-glucose cotransporter-2 (SGLT-2) inhibitor use in patients with heart failure (HF) and left ventricular ejection fraction (LVEF) more than 40% following the EMPEROR-Preserved (Empagliflozin Outcome Trial in Patients with Chronic Heart Failure with Preserved Ejection Fraction) and the DELIVER (Dapagliflozin Evaluation to Improve the Lives of Patients with Preserved Ejection Fraction Heart Failure) trials have major implications in the US.<\/jats:p><\/jats:sec><jats:sec id=\"ab-hoi220072-5\"><jats:title>Objective<\/jats:title><jats:p>To quantify the estimated US population-level impact of reducing worsening HF events with SGLT-2 inhibitors in individuals with LVEF more than 40%.<\/jats:p><\/jats:sec><jats:sec id=\"ab-hoi220072-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>This decision analytical model study used self-reported HF data from the National Health and Nutritional Examination Survey from 2015 to 2018, which was weighted across the entire US population and subsequently mapped onto newly eligible LVEF distributions from the Get With The Guidelines\u2013Heart Failure registry. All patients older than 18 years with HF from the National Health and Nutritional Examination Survey were grouped into the following categories: all LVEF and LVEF more than 40%. Numbers needed to treat estimations over 3 years were obtained for outcome measures from the EMPEROR-Reduced (Empagliflozin Outcome Trial in Patients with Chronic Heart Failure with Reduced Ejection Fraction), EMPEROR-Preserved, DAPA-HF (Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure), and DELIVER trials.<\/jats:p><\/jats:sec><jats:sec id=\"ab-hoi220072-7\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>Worsening HF events (unplanned HF hospitalizations, urgent HF visits requiring intravenous therapy, or cardiovascular death).<\/jats:p><\/jats:sec><jats:sec id=\"ab-hoi220072-8\"><jats:title>Results<\/jats:title><jats:p>A projected 4\u202f794\u202f524 (95% CI, 3\u202f997\u202f363-5\u202f591\u202f684) adults (57% male; 67% White; mean age, 66 years) with HF would be eligible for SGLT-2 inhibitors. Of this total population, 2\u202f619\u202f248 (95% CI, 2\u202f183\u202f759-3\u202f054\u202f737) would be estimated as newly eligible with LVEF more than 40%. Based on estimates from the EMPEROR-Reduced\/EMPEROR-Preserved and DAPA-HF\/DELIVER trials, a projected 624\u202f247 (95% CI, 520\u202f457-728\u202f037) to 627\u202f124 (95% CI, 522\u202f855-731\u202f392) worsening HF events could be prevented across the LVEF spectrum with SGLT-2 inhibitors over 3 years, of which 232\u202f589 (95% CI, 193\u202f918-271\u202f260) to 282\u202f879 (95% CI, 235\u202f846-329\u202f912) events could be prevented in individuals with LVEF more than 40%. Moreover, an estimated 468\u202f904 (95% CI, 390\u202f942-546\u202f867) to 499\u202f110 (95% CI, 416\u202f125-582\u202f094) total HF hospitalizations could be prevented across the LVEF spectrum, of which 172\u202f870 (95% CI, 144\u202f128-201\u202f613) to 231\u202f018 (95% CI, 192\u202f608-269\u202f428) could be prevented in individuals with LVEF more than 40%.<\/jats:p><\/jats:sec><jats:sec id=\"ab-hoi220072-9\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>In addition to the proven benefit in HF with LVEF of 40% and less, optimal implementation of SGLT-2 inhibitor therapy for HF with LVEF more than 40% can potentially prevent\/postpone an additional\u2009approximately\u2009250\u202f000 worsening HF events over 3 years in the US.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamacardio.2022.4348","type":"journal-article","created":{"date-parts":[[2022,11,5]],"date-time":"2022-11-05T16:30:47Z","timestamp":1667665847000},"page":"66","source":"Crossref","is-referenced-by-count":24,"title":["Population-Level Implications of Sodium-Glucose Cotransporter-2 Inhibitors for Heart Failure With Preserved Ejection Fraction in the US"],"prefix":"10.1001","volume":"8","author":[{"given":"Khawaja M.","family":"Talha","sequence":"first","affiliation":[{"name":"Department of Medicine, University of Mississippi Medical Center, Jackson"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javed","family":"Butler","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Mississippi Medical Center, Jackson"},{"name":"Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen J.","family":"Greene","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Duke University School of Medicine, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rahul","family":"Aggarwal","sequence":"additional","affiliation":[{"name":"Department of Medicine, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, Massachusetts"},{"name":"Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan D.","family":"Anker","sequence":"additional","affiliation":[{"name":"Department of Cardiology (CVK) and Berlin Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charit\u00e9 Universit\u00e4tsmedizin Berlin, Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian L.","family":"Claggett","sequence":"additional","affiliation":[{"name":"Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott D.","family":"Solomon","sequence":"additional","affiliation":[{"name":"Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John J. V.","family":"McMurray","sequence":"additional","affiliation":[{"name":"British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muthiah","family":"Vaduganathan","sequence":"additional","affiliation":[{"name":"Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregg C.","family":"Fonarow","sequence":"additional","affiliation":[{"name":"Ahmanson-UCLA Cardiomyopathy Center, University of California Los Angeles, Los Angeles"},{"name":"Associate Editor, JAMA Cardiology"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"22","key":"hoi220072r1","doi-asserted-by":"publisher","first-page":"2117","DOI":"10.1056\/NEJMoa1504720","article-title":"Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes.","volume":"373","author":"Zinman","year":"2015","journal-title":"N Engl J Med"},{"issue":"21","key":"hoi220072r2","doi-asserted-by":"publisher","first-page":"1995","DOI":"10.1056\/NEJMoa1911303","article-title":"Dapagliflozin in patients with heart failure and reduced ejection fraction.","volume":"381","author":"McMurray","year":"2019","journal-title":"N Engl J Med"},{"issue":"15","key":"hoi220072r3","doi-asserted-by":"publisher","first-page":"1413","DOI":"10.1056\/NEJMoa2022190","article-title":"Cardiovascular and renal outcomes with empagliflozin in heart failure.","volume":"383","author":"Packer","year":"2020","journal-title":"N Engl J Med"},{"issue":"16","key":"hoi220072r4","doi-asserted-by":"publisher","first-page":"1451","DOI":"10.1056\/NEJMoa2107038","article-title":"Empagliflozin in heart failure with a preserved ejection fraction.","volume":"385","author":"Anker","year":"2021","journal-title":"N Engl J Med"},{"issue":"12","key":"hoi220072r5","doi-asserted-by":"publisher","first-page":"1089","DOI":"10.1056\/NEJMoa2206286","article-title":"Dapagliflozin in heart failure with mildly reduced or preserved ejection fraction.","volume":"387","author":"Solomon","year":"2022","journal-title":"N Engl J Med"},{"issue":"12","key":"hoi220072r7","doi-asserted-by":"publisher","first-page":"1415","DOI":"10.1001\/jamacardio.2021.3651","article-title":"Potential implications of expanded US Food and Drug Administration labeling for sacubitril\/valsartan in the US.","volume":"6","author":"Vaduganathan","year":"2021","journal-title":"JAMA Cardiol"},{"issue":"6","key":"hoi220072r8","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1001\/jamacardio.2018.0579","article-title":"Association of hospital performance based on 30-day risk-standardized mortality rate with long-term survival after heart failure hospitalization: an analysis of the Get With The Guidelines-Heart Failure Registry.","volume":"3","author":"Pandey","year":"2018","journal-title":"JAMA Cardiol"},{"issue":"5","key":"hoi220072r9","doi-asserted-by":"publisher","first-page":"646","DOI":"10.1002\/clc.v44.5","article-title":"Contemporary economic burden in a real-world heart failure population with commercial and Medicare supplemental plans.","volume":"44","author":"Lam","year":"2021","journal-title":"Clin Cardiol"},{"issue":"11","key":"hoi220072r10","doi-asserted-by":"publisher","first-page":"1219","DOI":"10.1007\/s40273-020-00952-0","article-title":"A systematic review of medical costs associated with heart failure in the USA (2014-2020).","volume":"38","author":"Urbich","year":"2020","journal-title":"Pharmacoeconomics"},{"issue":"3","key":"hoi220072r11","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.121.009099","article-title":"Out-of-pocket costs for SGLT-2 (sodium-glucose transport protein-2) inhibitors in the United States.","volume":"15","author":"Aggarwal","year":"2022","journal-title":"Circ Heart Fail"},{"issue":"25","key":"hoi220072r12","doi-asserted-by":"publisher","first-page":"3370","DOI":"10.1016\/j.jacc.2018.08.2202","article-title":"Prescriber patterns of SGLT2i after expansions of U.S. Food and Drug Administration labeling.","volume":"72","author":"Vaduganathan","year":"2018","journal-title":"J Am Coll Cardiol"},{"issue":"3","key":"hoi220072r13","doi-asserted-by":"publisher","first-page":"313","DOI":"10.1097\/FJC.0000000000000864","article-title":"Antihyperglycemic therapies with expansions of US Food and Drug Administration indications to reduce cardiovascular events: prescribing patterns within an Academic medical center.","volume":"76","author":"Hamid","year":"2020","journal-title":"J Cardiovasc Pharmacol"},{"key":"hoi220072r6","unstructured":"National Health and Nutrition Examination Survey, 2015-2018: sample design and estimation procedures: data evaluation and methods research. 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